Tidal irrigator and cystometer



Patented Nov. 1, 1949 TNT -FFICE TIDAL IRRIGATOR AND GYSTOMETER Stanford A. Henderson, Buffalo, N. Y., assignor to Gomco Surgical Manufacturing Corp., Buffalo, N. Y., a corporation of New York Application October 24, 1947, Serial No. 781,905

(Cl. I28-227) 15 Claims.

This invention relates to a tidal irrigator and cystometer and more particularly to such an irrigator and cystometer used for regular alternate emptying and filling of the bladder and for making cystometrograms. Such apparatus is particularly successful in caring for functional changes in association to the spinal cord and cauda equina or wherever alternate drainage and filling of the bladder is indicated.

One of the principal objects of the present invention is to provide such atidal irrigator which is simple in construction and efficient in operation and in particular. is devoid of complicated connections, reservoirs and valves, its operationalprinciple being based on gravity.

Another object is to provide such a tidal irrigator which can be operated with a minimum attention onthe part of the operator.

Another object is to provide such a tidal irrigator which can be easily cleaned and sterilized,

a small number of large and uniformly sized, readily accessible tubes being used in its construction for this purpose.

Another object is to provide a stable, simple, accurate and readily adjusted control for regularly emptying and refilling the bladder at an adjustable level of intravesical pressure, in particular in which the control of the operation of the irrigator is through an air lock in contradistinction to the restricted orifices heretofore used, the air lock of the present invention avoiding the disadvantages inherent in a control depending upon a restricted orifice and also insuring against air entering the drainage legs until the bladder is fully emptied, thereby to insure complete emptying of the bladder on each alternation of the irrigator.

Another object is to provide such a tidal irrigator, the operation of which can be readily explained to house ofiicers and nurses.

Another object is to provide such a tidal irrigator which can be used for making cystometrograms.

Other objects and advantages of the invention will appear from the following description and drawings in which Fig. l is a front elevational view of a tidal irrigator and cystometer embodying the present invention.

Fig. 2 is a fragmentary side elevational view thereof.

Fig. 3 is an enlarged fragmentary front elevational view, partly in section, of a part of the apparatus.

Fig. 4 is an enlarged horizontal section taken on line fl4, Fig. 1.

The tidal irrigator, and cystometer forming the subject of the present invention is adapted to be readily moved to and from the bedside of the patient to be treated and for this purpose is shown as comprising an upright standard including a supporting rod to mounted on a spider II, the arms of which have casters [2 which permit the irrigator to be readily rolled from place to place. A tube [3 is telescopically supported on the upright rod 50 and is held. at any adjusted elevation by a setscrew M. This setscrew also extends through and supports the tubular support l5 for an arm or bracket l6 carrying a stand or platform [8 for a waste or drainage bottle [9, this tubular portion l5 embracing the lower end of the telescopic tube l3.

The upper end of the telescopic tube it is provided with a cap 20 having an angularlydisposed cylindrical extension 2| which is provided. with a pair .of opposite, axially extending slots to receive and support the bottom bail 22 of an inverted reservoir bottle 23 which contains the solution used in irrigating the bladder. The neck of this inverted reservoir bottle 23 is carried in a pair of prongs of a supporting bracket 2t projecting outwardly from the telescopicsupporting tube l3 and to this neck is secured a conventional air vent stopper 25. The outlet from this air vent stopper connects with a flexible tube 26 provided with a conventional hose clamp 2'6 which can be adjusted to regulate the rate of discharge of the solution from the reservoir bottle 23. The lower end of the flexible tube 26 connects with a conventional transparent dropper 28 through which the rate of discharge of the solution can be ob served and timed.

The remainder of the parts are supported by an upright elongated panel 30 carried by upper and lower brackets 3! projecting outwardly from the telescopic supporting tube It. This panel 3a. is preferably made of a transparent plastics-rid can be secured to the brackets 31 so as to be readily removable therefrom by screws 3?. or in any other suitable manner. This panel is provided along its bottom. edge, one vertical edge and the lower part of its opposite vertical edge with a rounding groove. 33 adapted to receive the two parallel upright transparent branch tubes 34 and 35 and a horizontal tube 36 connecting the two parallel branch tubes 34 and 35 a short distance above their lower ends. It will be seen that the tubes 34, 35 and 36 constitute a U-tube having upright branches. This horizontal connecting tube 36 is fused air tight to the lower ends of the,

branch tubes 3i and 35. The three so connected tubes or U-tube 34, 35 and 36 can be secured in the grooves 33 cementitiously or in any other suitable manner.

The lower end of each of the branch tubes 34' and 35 is closed by a removable stopper 31. These stoppers are held in the branch tubes by the ends of a leaf spring 38 pivoted at its center, as indicatedat 39, to a block 40 shown as secured to the underside of the connecting tube 36. By

3 the simple expedient of turning the leaf spring about the pivot 39 its ends are removed from under the stoppers 38 which can then be readily removed to permit cleaning of the U-tube 34, 35, 36.

The upright branch tube 34 is higher than the upright branch tube 35, the former rising to the top of the panel 30 and having an open upper end into which the solution from the bottle or reservoir 23 is discharged by the dropper 28. The shorter branch tube 35 is provided near its top with a horizontal branch or nipple which is connected with a length of flexible tubing 4|. The opposite end of this length of flexible tubing is connected with a catheter (not shown) of the type ordinarily used in irrigating the bladder of a patient. The connection between the shorter branch tube 35 and the length or flexible tubing 4| is disposed at the zero point on a vertical scale 42 provided on the upper part of the panel 3|], this scale being preferably calibrated in centimeters of water above its zero level. The zero point on the scale 42 also represents the symphysis level and must be adjusted to the patients symphysis pubis.

A vertical metal strip 43 is secured to the forward face of the plastic panel 30 alongside this scale 42. This metal strip is provided with "a vertical series of uniformly spaced threaded holes 44 adapted to receive a thumb screw 45. Iliis thumb screw extends through a threaded hole in a supporting block 45 having side flanges 48- which embrace the sides of the metal strip 43 so as to hold the supporting block 46 in the horizontal position shown. This supporting block is provided with a pair of spaced vertical bores 49 bottle 23 is replaced by air admitted by the air vent stopper for the reservoir bottle, and the irrigating solution passes from the conventional dropper 28 into the upper end of the branch tube 34, which upper end is open to the atmosphere.

The solution dripping into the open upper end of the branch tube 34 at the rate determined by the hose clamp 21 flows to the bottom of this tube, across the connecting tube 36, into the other branch tube and fills all three of these tubes, thesolution level in both vertical branches 34 and 35 formed by this U-tube rising equally. When this level rises ito the zero mark on the scale 42. the solution flows through the flexible tubing 4| into the bladder. When the bladder is filled to capacity, or to the optional intravesical pressure as determined by the elevation of the siphon loop 5|, the pressure of the accumulating solution in the branch tube 34 forces the solution to rise in the end 52 of the length of flexible tubing 50 leading to the siphon loop 5|. When this column of solution reaches the top of the siphon loop 5|, it spills over the loop emptying into the end 53 of the flexible tubing leading to the waste bottle I9. At the point of spill-over, siphon action is initiated and negative pressure is established in the end 52 of the flexible tubing 50 which will either lift the column of solution in the vertical branch tube 35, or will draw the solution from the bladder. Since it is easier to siphon liquid from a reservoir closer to the force of negative pressure (as the solution in the bladder) than through which a length of flexible tubing 50 is passed so as to form a small upstanding siphon loop 5| above the block 46. One end 52 of the flexible tubing 50 has an air tight connection with the upper end of the shorter bnanch tube 35 while its other end 53 discharges into the waste bottle E9. The outlet of the end 53 of the tubing 50 is at a lower level than the U-tube 34, 35 and 36, the tubing 55 :providing a siphon having a long leg 53.

In the use of the tidal irrigator and cystometer, with the reservoir bottle 23 filled with any of the usual solutions used in bladder irrigation, the symphysis level marked by the zero point of the scale 42 on the panel 30 is adjusted to the level of the patients symphysis pubis by loosening the setscrew l4 and raising or lowering the telescopic tube l3 of the standard along the supporting rod iii of the standard and thereafter tightening the setscrew it. Since the panel 3|] is fast to the telescopic tube 43 of the standard it will be seen that the zero point of the scale 42 can be brought to any level. Following this the operator adjusts the height of the loop 5! to provide the desired intravesical pressure which the patient requires. This vertical adjustment of the loop 5| is readily efiected by unscrewing the thumb screw 45 far enough to release it from the corresponding threaded hole 44 in the metal plate 43 and moving the block 48 up or down to adjust the loop 5| to the desired level. Following this the thumb screw 45 is screwed into one of the series of holes 43 at the selected level to retain the loop 5! at this level.

The operation then opens the hose clamp '21 to allow the irrigating solution to drip by gravity from the reservoir bottle 23 at any desired rateusually from 30 to drops per minute. The irrigating solution removed from the reservoir to lift a column of liquid against gravity (as the column 0f solution in the vertical branch tube 35), the bladder is emptied first, while the solution in the vertical branch tube 35 acts as an air lock. Only after the bladder is completely empty will the column or solution in the vertical branch tube 35 be lifted and the air lock broken, terminating siphon action and completing the irrigation-drainage cycle.

The cycle then automatically repeats itself so that alternate filling and emptying of the bladder is automatic, and requires no attention except to fill the reservoir bottle 23 with the solution and to empty the waste bottle [9. To check the circuit for obstruction, the operator observes the presence or absence of up and down excursions of the solution column in the vertical branch tube 34. These excursions indicate respiratory movements as transmitted by-the bladder and if absent indicate obstruction within the lumen of the catheter or tubing.

The fact that, during siphoning, the column of solution in the vertical branch tube 35 acts as an air lock until the bladder is completely emptied and that air cannot enter the siphon circuit until the negative pressure of the siphon circuit has raised the solution from the branch tube 35 until air is allowed to enter from the connecting tube 36 is one of the important features that give the irrigator of the present invention its stability and superiority over similar apparatus used for this work.

The apparatus now in common use for bladder irrigation attempts to control the siphon break by retarding the air inflow to the siphon. While this method will operate satisfactorily when properly adjusted and under ordinary conditions, it is apt to be erratic in operation, particularly when set up by one who is not thoroughly familiar with the apparatus. The sensitivity to adjustment is mainly caused by the small differential pressures between the incoming air and the siphon demand supplied by the bladder solution.

If this demand is not as required, then the incomto break and ending further drainage from the bladder.

This variation may be created by several conditions, such as obstruction in the bladder tubing, using a catheter or tubing with too small a lumen, by heavy viscous material being drained from the bladder, by small air bubbles in the bladder tubing, or it may be caused by the patients voluntarily altering the bladder pressure.

These conditions which are met in irrigating work will not affect the operation of the present apparatus unless carried to an extreme, because in order to break the siphon the condition tending to cause this break must resist a negative pressure equal to the weight of solution in the column below the plane of the bladder.

It will be noted that the panel 30 is scaled as indicated at 42 in centimeters of water for the purpose of making cystometric determinations. With a convenient height of the panel 30 and the vertical branch tube 34, readings are usually only possible up to 50 centimeters. Therefore, cystometric determination of hypertonic dysfunction of the bladder will be incomplete, as will determinations of maximum voluntary effort pressures. However, this panel and vertical branch tube could be increased to permit such determinations and the shorter scale is adequate for determining the optional intravesical pressure at which the siphon loop should be set for all types of therapy in bladder dysfunction. For cystometry the symphysis or zero mark on the scale 42 is set at the level of the patients symphysis pubis, the circuit is filled, air free, with sterile normal saline or sterile water, and a clamp applied to the end of the flexible tubing 4| which connects to the catheter. The column of liquid in the vertical branch tube 34 is then adjusted to zero on the scale 42, by allowing more liquid to run into the tube if below zero, or allowing some of the liquid to escape from the flexible tube 4! connecting with the catheter if above zero. When the level is so adjusted to zero, the operator clamps the flexible tubing 4i connecting with the catheter. The operator then clamps the end 52 of the flexible tubing 56, which end connects the vertical branch tube 35 with the siphon loop 5i. The operator then notes and charts the liquid level in the reservoir bottle 23 at this zero reading. He then loosens the clamp from the flexible tubing 4i leading to the catheter and opens the hose clamp 21 to allow the liquid to drip into the system at some 30-60 drops per minute. From here on procedure is the same as for any other type of cystometric determination. Increments of 50 cc. to 100 cc. of liquid are run into the bladder from the reservoir bottle 23, which is preferably graduated for this purpose, and readings are taken from the scale 42 on the panel 30. The clamp placed on the end 52 of the flexible tubing 50 between the vertical branch tube 35 and siphon loop 5i should not be removed while cystometric determination is being made.

To clean and sterilize the apparatus, the operator releases the neck of the reservoir bottle 23 from the holding prongs of the bracket 24, disconnects the lower end of the dropper 28 and lifts the reservoir bottle 23 from the standard. The flexible tubing connections are then removed. The assembly of the panel 30 and U-tube 34, 35, 36 is then disconnected by removing the screws 32 which secure the panel to the telescopic tube I3 of the standard. The waste bottle I9 is removed and thesiphon loop 5'! is removed by unscrewing the thumb screw 45. The leaf spring 38 at the bottom of the panel 30 is then given a half turn to the right or left about its pivot 39 and the stoppers 31 removed from the lower end of the vertical branchtubes 34-, 35. The operator then soaks all flexible tubing, the reservoir bottle 23, dropper 28 and stoppers in a soap solution and cleanses until all encrustations and discolorations are removed. The vertical branch tubes 34, 35 fixed to the: panel 30 are cleaned with a long handled brush whichv is soaked and inserted through the lower ends of these vertical branch tubes and moved with a piston action. The transverse connecting tube 36 at the bottom of the panel 30 is cleaned by threading a piece of soap-saturated gauze or cotton on an applicator. All soapcleaned parts are thoroughly rinsed. Following this the apparatus is reassembled and preferably sterilized with cyanide of mercury before reuse.

It will particularly be noted that the construction ofthe apparatus, particularly the mounting and stoppering of the U-tube assembly34, 35, 36 carried by the panel 30, greatly facilitates this cleaning operation.

From the foregoing it will be seen that the present invention provides a simplified but thoroughly efficient tidal irrigator and cystometer which is devoid of complicated connections, reservoirs and valves, its operational principle being based on gravity, siphon action and negative hydrostatic pressure so as to be accurate, sensitive and stable. Further, the unit is so constructed that minimal attention is required in its automatic operation and so that it can be easily cleaned and sterilized.

I claim:

1. A tidal irrigator, comprising a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of tubing connected with the other branch of said U-tube a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, and a second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said. second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said .U-tube provides an air lock. and thereafter lift said column of liquid in said other branch of said U-tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle.

2. A tidal irrigator, comprising a rigid U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of flexible tubing connected with the other branchof said U-tube' a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, and a second length of flexible tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of flexible tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of flexible tubing, thereafter fills said first length of flexible tubing and the bladder, thereafter fills said one end of said second length of flexible tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of flexible tubing to establish siphonic action and negative pressure in said one end of said second length of flexible tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U-tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle.

3. A tidal irrigator, comprising a U-tube having long and short upstanding branches, means for admitting measured amounts of liquid into the longer branch of said U-tube, a generally horizontal length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of of the patient, a second length of tubing connected with the upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle.

4. A tidal irrigator, comprising a standard, a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of tubing connected with the other branch of said U-tube a substantial distance above the bottom thereof and adapted to be connected with the bladder or the patient, means for supporting said U-tube on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and said other branch of said U-tube to the level of the patients symphysis pubis, and a second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U- tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U-tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle.

5. A tidal irrigator, comprising a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of tubing connected with the other branch of said U-tube a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, a second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U-tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle, and means for adjusting the elevation of said siphon loop with reference to said U-tube to adjust said intravesical pressure.

6. A tidal irrigator, comprising a standard, a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U -tube, a generally horizontal length of tubing connected with the other branch of said U-tube a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, means for supporting said U-tube on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and said other branch of said U-tube to the level of the patients symphysis pubis, a second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquidfirst fills said U-tube to the level of said firs-t length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of tubing toestablish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U -tube until air is drawn through the lower end of said -U -tube to break said siphonic action and complete the cycle, and means for adjusting the elevation of said siphon loop with reference to said U-tube to adjust said intravesical pressure.

'7. A tidal irrigator, comprising a standard, a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of tubing connected with the other branch of said U-tube a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, means for supporting said U -tube on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and said other branch of said U-tube to the level of the patients symphysis pubis, a

second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of saidsiphon loop and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U-tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle, and a vertical scale fixed to said U -tube and having a lower zero point level with said connection between said generally. horizontal length of tubing and said other branch of said U-tube to indicate said symphysis level, said scale being graduated to indicate the elevation of said liquid in said one branch of said U-tube.

8.. A tidal irrigator, comprising a standard, a U-tube having upstanding branches, means for admitting measured amounts of liquid into one branch of said U-tube, a generally horizontal length of tubing connected with the other branch of said LI -tube a substantial distance above the bottom thereof and adapted to be connected with the bladder of the patient, means for supporting said U-tube on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and said other branch of said U-tube to the level of the patients symphysis pubis, a second length of tubing having one end connected with said other branch of said U-tube a substantial distance above the bottom thereof, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of said -U-tube whereby admitting measured amounts of liquid first fills said U -tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop and thereafter spills over said siphon loop into said other end of said second length of tub 'ing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said other branch of said U-tube provides an air lock and thereafter lift said column of liquid in said other branch of said U -tube until air is drawn through the lower end of said U-tube to break said siphonic action and complete the cycle, means for adjusting the elevation of said siphon loop with reference to said U-tube to adjust said intravesical pressure, and a vertical scale fixed to said U-tube alongside said one branch of said U-tube and said siphon loop and having a lower zero point level with said connection between said generally horizontal length of tubing and said other branch of said U-tube to indicate said symphysis level, said scale being graduated to indicate the level of said liquid in said one branch of said U-tube and the elevation of said siphon loop.

9. Atidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches, means for admitting measured amounts of liquid into the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said .U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a record length of flexible tubing having one end connected with the upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid. first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negativepressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure.

10. A tidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches, means for admitting measured amounts of liquid into the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected with the upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of saidsecond length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second 'length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure comprising a vertical series of holes provided in said panel, a holder for said siphon f loop, and a pin on said holder and insertable into any of said holes to adjust said siphon loop to a corresponding elevation.

11. A tidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches, means for admitting measured amounts of liquid into the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected with the upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure, comprising a vertical series of threaded holes provided in said panel at the upper end thereof, a holder for said siphon loop, and a screw threaded in an opening extending through said holder and adapted to be screwed into any of said holes to adjust said siphon loop to a corresponding level.

12. A tidal irrigator, comprising a support, a vertical panel, a rigid transparent U-tube secured to said panel and having long and short upstanding branches, means for admitting measured amounts of liquid into the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected with the upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure, said panel being provided with a vertical scale having a zero point level with said connection between the generally horizontal length of tubing and said shorter branch of said U-tube to indicate said symphysis level, and said scale being graduated to indicate the elevation of said liquid in said longer branch of said U,- tube and the elevation of said siphon loop.

13. A tidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches open at their upper and lower ends and a horizontal tube connecting said branches adjacent the lower ends thereof, a stopper in the lower end of each of said branches, means for admitting measured amounts of liquid into the open upper end of the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected in sealed relation to the open upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined-by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to firstempty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure.

14. A tidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches open at their upper and lower ends and a horizontal tube connecting said branches adjacent the lower'ends thereof, a stopper in the lower end of each of said branches, a latch carried by said panel and engageable with said stoppers to retain I them in said branches, means for admitting measured amounts of liquid into the open upper end of the longer branch of said U-tube, a generally horizontal flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected in sealed relation to the open upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder while the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure.

15. A tidal irrigator, comprising a support, a vertical panel, a rigid U-tube secured to said panel and having long and short upstanding branches open at their upper and lower ends and a horizontal tube connecting said branches adjacent the lower ends thereof, a stopper in the lower end of each of said branches, 9, spring leaf pivoted at its center on said panel to swing about a vertical axis between said stoppers and arranged with its ends to engage the undersides of said stoppers and retain them in said branches, means for admitting measured amounts of liquid into the open upper end of the longer branch of said U-tube, a generally horizontally flexible length of tubing connected with the upper end of the shorter branch of said U-tube and adapted to be connected with the bladder of the patient, means supporting said panel on said standard for adjustment in a vertical direction to permit of adjusting the connection between said generally horizontal length of tubing and the shorter branch of said U-tube to the level of the patients symphysis pubis, a second length of flexible tubing having one end connected in sealed relation to the open upper end of said shorter branch of said U-tube, said second length of tubing extending upwardly from its connection with said U-tube and being formed to provide an elevated siphon loop and its other end extending downwardly below the bottom of the U-tube whereby admitting said measured amounts of liquid first fills said U-tube to the level of said first length of tubing, thereafter fills said first length of tubing and the bladder, thereafter fills said one end of said second length of tubing to said siphon loop to provide an intravesical pressure determined by the elevation of said siphon loop, and thereafter spills over said siphon loop into said other end of said second length of tubing to establish siphonic action and negative pressure in said one end of said second length of tubing thereby to first empty the patients bladder While the column of liquid in said shorter branch of said U-tube provides an air lock and thereafter lift said column of liquid in said shorter branch of said U-tube to break said siphonic action and complete the cycle, and

- means carried by said panel for adjusting the elevation of said siphon loop to adjust said intravesical pressure.

STANFORD A. HENDERSON.

No references cited. 

